Prolotherapy: Potential for the Treatment of Chronic Wounds?

Content Provider	Europe PMC
Author	Siadat, Amir Hossein Isseroff, Roslyn Rivkah
Copyright Year	2019
Abstract	Significance: Chronic skin ulcers, including venous, diabetic, and pressure ulcers, constitute a major health care burden, affecting 2–6 million people in the United States alone, with projected increases in incidence owing to the aging population and rising epidemic of diabetes. The ulcers are often accompanied by pain. Standard of care fails to heal ∼50% of diabetic foot ulcers and 25% of venous leg ulcers. Even advanced therapies do not heal >60%. Thus there is an unmet need for novel therapies that promote healing and also address the concomitant pain issue. Recent Advances: Prolotherapy involves injection of small amounts of an irritant material to the site of degenerated or painful joints, ligaments, and tendons. Multiple irritants are reported to be efficacious, but the focus here is on dextrose prolotherapy. In vitro and in vivo studies support translation to clinical use. Concentrations as low as 5% dextrose have resulted in production of growth factors that have critical roles in repair. Numerous clinical trials report pro-reparative effects of dextrose prolotherapy in joint diseases, tendon, and ligament damage, and for painful musculoskeletal issues. However, most of the studies have limitations that result in low-quality evidence. Critical Issues: The preclinical data support a role for dextrose prolotherapy in promoting tissue repair that is required for healing chronic wounds and ameliorating the associated pain. Critical issues include provision of evidence of efficacy in human chronic wounds. Another potential obstacle is limitation of reimbursement by third-party payers for a therapy with as yet limited evidence. Future Directions: Preclinical studies in models of chronic wounds would support clinical translation. As dextrose prolotherapy has some mechanistic similarities to already approved honey therapies, it may have a shortened pathway for clinical translation. The gold standard for widespread adoption would be a well-designed clinical trial.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6804793&blobtype=pdf
Page Count	8
ISSN	21621918
Volume Number	8
DOI	10.1089/wound.2018.0866
PubMed Central reference number	PMC6804793
Issue Number	4
PubMed reference number	31646060
Journal	Advances in Wound Care [Adv Wound Care (New Rochelle)]
e-ISSN	21621934
Language	English
Publisher	Mary Ann Liebert, Inc., publishers
Publisher Date	2019-04-03
Publisher Place	USA
Access Restriction	Open
Rights License	Copyright 2019, Mary Ann Liebert, Inc., publishers
Subject Keyword	prolotherapy chronic wounds diabetic ulcer wound healing
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine Critical Care and Intensive Care Medicine